Virginia Regulatory Town Hall
Department of Health Professions
Board of Dentistry
Regulations Governing Dental Practice [18 VAC 60 ‑ 20]
Action Sedation and anesthesia permits for dentists
Stage Emergency/NOIRA
Comment Period Ended on 11/7/2012
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10/29/12  12:31 pm
Commenter: Christopher Hamlin, DDS

Oral Sedation regulations

While applaud the Board of Dentistry's effort to make sedation safer in dental offices, I am dismayed that a valuable tool has been removed from my practice to provide a positive experience for my patients. We have routinely prescribed Atarax for young patients, to be taken in the comfort of the home.  We prescribe the amount for the appointment, so an overdose is unlikely and in the event of an inadvertant pharmacological filling error.  it is recognized that the medication has an unprecedented margin of safety.  We use no other drugs in our office.  We do use Nitrous Oxide and our patients are alert and responsive throughout the procedure.  For older children we prescribe Valium to be taken at home prior to the appointment.  Again, prescribing the amount only for that appointment. I think most would agree that a 5 mg tablet of Valium would be safe for a child in the 7-12 age group.  Since we have been in compliance with the "emergency regulations", we have discovered that parents are not willing to pay the extra fees involved for the "sedation" that we must charge for the administration, ordering, record keeping, etc.. Also they are not willing to come in an extra hour in advance of the appointment.  There is no insurance code that fits this procedure, therefore there is no insurance reimbursement. The prescriptions were covered by insurance.  And we are left with the difficulty of treating these children and the emotional aftermath of the appointments.  Pediatric dental offices are overwhelmed with children who have difficulties, for whatever reason, in obtaining dental care.  The burgeoning population of autistic children, who require Valium, just for a prophylaxis and examination is staggering.  To have this safe and effective medication removed from our armamentarium, has been a huge disaster for our patients.

In review of the untoward situations that have occured with children in the dental offices, it is important to note that most involved the administration of oral Chloral Hydrate, BY the dentist, IN the dental office.  I would suggest that my administering Atarax and Valium in my office would not change this type of occurence.  The problem is more about the kind of medication not where it is administered.  So I would propose that the schedule of the type of drugs be limited for prescribing at home, rather than a blanket  prohibition of safe and effective medications, which can be administered at home by parents. Sincfor

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